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Peripheral vascular disease refers to blockages in arteries of the
brain, kidneys, and legs. Peripheral vascular disease is a form of atherosclerosis,
also known as hardening of the arteries, and is a progressive disease process.
Atherosclerosis
is caused when fatty substances build up inside the artery walls over time
and create a narrowed opening which restricts proper blood flow. This build
up is most likely to occur in the iliac arteries (lower abdomen leading
to the legs), the femoral and popliteal arteries (legs), the renal arteries
(kidneys) and the carotid arteries (in the neck leading to the brain).
DISEASE SYMPTOMS
When organs and muscles in the body receive an insufficient supply of oxygen-rich
blood, they literally become starved and alert you to this fact by producing
pain. If the blockage occurs in the arteries supplying the legs, the resulting
symptom is a cramping pain in the hips, thighs or calf muscle and can limit
even casual walking. If the cycle of pain is relieved with rest, we call
the condition intermittent claudication. Pain that occurs during rest can
sometimes be alleviated by lowering the legs so the force of gravity shunts
blood into the feet. If blood circulation becomes so severely restricted
that the legs and feet are perpetually starved for nutrition, gangrene--or
death of the tissue-- can occur. Without treatment, the entire foot or
possibly part of the leg may have to be amputated.
Other symptoms of peripheral vascular disease in the lower extremity include:
coldness of the leg and foot; paleness of the leg or foot if elevated;
blue/red discoloration of the foot or toes; loss or decreased growth of
hair on the legs; dry, fragile or shiny-looking skin; numbness, tingling
or pain in the leg, foot or toes; sores that do not heal.
Other conditions can also cause these symptoms. Therefore, a thorough examination
with a physician is necessary.
Symptoms of peripheral vascular disease in the carotid arteries include:
sudden, temporary weakness or numbness of the face, arm and/or leg on one
side of the body; temporary loss of speech or trouble speaking or understanding
speech; temporary dimness or loss of vision, particularly in one eye; unexplained
dizziness, unsteadiness or sudden falls. Transient Ischemic Attacks (TIA’S)
are mini-strokes and illicit the same symptoms named above except they
are temporary. At this time, carotid atherosclerosis can only by corrected
by surgery.
Symptoms of
peripheral vascular disease in the renal arteries include; hypertension
(high blood pressure-consistently higher than 140/90); abnormal kidney
function blood tests.
DIAGNOSIS
When any of the above-named symptoms occur, a history and physical examination
accompanied by an ultrasound Doppler test are initially performed. The
ultrasound Doppler test visualizes the inside of the arteries using sound
waves to determine if there is plaque buildup, and if so, to what extent.
This test is simple and painless.
If the test shows that the stenosis
(or narrowing of the artery) is severe, then a test called an arteriogram
or aortagram will give your physician the complete information he or she
needs to properly diagnosis your condition.
ARTERIOGRAM/AORTAGRAM
Procedure Overview
During the procedure your physician will insert a long, thin tube into
a blood vessel in your groin or arm. The tube will be gently directed to
the level of your belly button. A contrast dye is then injected into your
legs while x-ray pictures are taken.
This procedure can be performed on an outpatient basis at the Heart & Vascular Center.
In preparation for your test, blood work will be ordered one to two days
before the scheduled date. The day of the procedure, you will be asked
to arrive early to the lab and someone should be able to drive you home.
About one hour before the procedure, an intravenous line will be started.
You will remain awake throughout the procedure. It takes approximately
thirty minutes to take the pictures. Once the procedure is complete, the
catheter tube will be removed and firm pressure will be applied to the
entry site for approximately thirty minutes; also a large, tight pressure
dressing will be applied. You will return to your room or recovery area
where you will need to lie flat in bed for three to four hours.
When the dressing
is removed, you will notice a small bruise at the catheter insertion site,
no larger than the size of a quarter. You may also feel a hard lump. It
is normal to expect the bruise to become slightly larger and darker the
first few days you are home. They are the result of the body’s normal healing
process and should completely disappear in about two weeks. If you become
uncomfortable or are experiencing any discomfort, please call our office
immediately.
TREATMENT ALTERNATIVES
Many treatments can be used to improve blood flow
through the arteries. The latest interventions for treating vascular disease
can bring swift relief and more cost effective than surgery. Most procedures
require no more than an overnight hospital stay. Patients enjoy an early
return to most normal activities. Devices now available include balloon
catheters, stents, atherectomy and lasers. All these alternatives treat
the build-up of plaque by either removing it, compressing it or displacing
it. During these procedures the physician will periodically inject a contrast
dye and take x-ray pictures to determine whether or not the artery is sufficiently
opened. If the blockage is extremely long or has become very hard and calcified
with time, it may be resistant to any of these interventions. In these
cases, surgery may be required to bypass the problem area.
TREATMENT PROCEDURES
What to Expect
Preparation for the interventional procedures is similar to the diagnostic
aortagram. Usually patients are admitted to the hospital in the morning
for all the pre-procedure testing with the procedure itself being performed
later the same day. Discharge from the hospital usually occurs the following
morning.
Balloon Angioplasty
Balloon Angioplasty is now the most common method used for opening an obstructed
artery. A thin floppy wire is first passed through the narrowed opening
in the artery. A deflated balloon is passed along the wire to the obstructed
area. The balloon is inflated and deflated, sometimes more than once, often
in more than one location. This compresses the plaque against the inside
of the artery wall and increases the size of the opening. Balloon angioplasty
may be used alone to treat the affected area, or can be used in combination
with the other therapies.
Stents
If an artery that has been opened should happen to close or re-narrow during
the procedure, a device called a Stent may be inserted to hold the vessel
open. It is a small, metal expandable lattice-shaped tube that mounts onto
a deflated balloon. When the catheter has positioned the balloon at the
blockage site, the balloon is inflated and the stent expands. The balloon
and catheter are removed, leaving the stent in place to keep the artery
open.
Atherectomy
An atherectomy catheter has a small rotating cutter at it’s tip that shaves
and removes plaque from the artery. Once the plaque is removed, the artery
is sufficiently open to restore improved blood flow.
Laser Angioplasty
A laser device
creates a cool, high intensity light beam that concentrates on a very small
area. Laser light travels through a fiberoptic tube much like water running
through a hose. The laser probe is gradually advanced through the area
of obstruction until a channel is opened, permitting blood to flow freely.
The laser beam vaporizes plaque without damaging the surrounding tissue.
AFTER THE PROCEDURE
A nurse will monitor
your vital signs and frequently check the pulse in your groin area, behind
your knees and at your ankles and feet. Like the aortagram procedure done
outside the hospital. you will lie flat in bed for a few hours before the
doctor allows you to get up and move around again.
DISCHARGE
Upon your discharge,
you will be given instructions about medications which will help keep the
arteries open, diet counseling and an exercise prescription. Our Heart
Center Vascular Rehabilitation program may be prescribed for you so we
can closely monitor your progress. A follow-up ultrasound Doppler test
will be scheduled two weeks following your treatment and then at six to
twelve month intervals to keep a close watch on blood flow in your lower
extremities.
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